Rare opportunity to gain insight into BFCC-QIO’s perspective on short-stay inpatient admissions, to help improve decisions and reduce denials
Harrisburg, PA - Executives from McKesson Health Solutions and KEPRO will share the podium at the ACMA 2016 National Conference to help providers better understand how to reduce denials, the Centers for Medicare & Medicaid Services’ (CMS) final Two-Midnight Rule and the Beneficiary and Family Centered Care audit process. Co-presenting at the conference, being held April 2-6 in Tampa, Fla., will be Tammie Phillips R.N., McKesson’s Vice President, Business Consulting, and Cheryl Cook R.N., KEPRO’s Program Director for CMS Areas 2 and 4.
“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations”
Their interactive session, “Denials Management, the Two-Midnight Rule, and the QIOs Perspective,” will be held on April 5th at 10:30 a.m. ET. Phillips and Cook will discuss provider trends and challenges around denials management, with particular focus on the impact of the updated rule. They will share insights on the BFCC-QIO audit process and expose common gaps in provider workflows. This is a unique opportunity to hear perspectives directly from one of only two BFCC-QIOs charged by CMS to audit short-stay claims and ask questions.
“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations,” Phillips says. “Knowing what to expect requires an understanding of correct documentation of medical necessity, how the QIOs will conduct the audit process and the tools they will use to support their short-stay inpatient reviews. Our session will shed light on these challenges and opportunities, which are crucial advantages for reducing denials.”
The 23rd annual American Case Management Association (ACMA) National Conference will convene over 1,500 case management and transitions of care professionals for ongoing training, education, and networking, to strengthen their skills within the practice setting. A long-time supporter of ACMA, McKesson will be exhibiting and answering attendees’ questions at ACMA booth #312.
For more information on the ACMA 2016 National Conference, visit http://casemanagementconference.com. For more information about McKesson Health Solutions, please visit www.mckesson.com and follow us on Twitter at @McKesson_MHS. For more information about KEPRO, please visit our website, ‘Like’ us on Facebook or follow us on Twitter at @KEPRO_PA. Read More
HARRISBURG, PA – KEPRO announced today it was recently awarded a new contract with the state of Minnesota to manage the Emergency Medical Assistance Program on behalf of the Minnesota Department of Human Services.
“We’re excited to expand our services for the state of Minnesota,” said Joe Dougher, President and Chief Executive Officer. “Over the past 3 years we have worked to provide utilization management for the state’s Medicaid program and this opportunity allows us to further enhance our healthcare services for Minnesotans.”
KEPRO currently manages Minnesota’s Fee-for-Service Medicaid program and helps 315,000 members receive the quality care they need through utilization management. KEPRO’s clinical team, based in Bloomington, determines the medical necessity of various healthcare procedures, treatments, and health services, including mental health services for both children and adults, dental services, and durable medical equipment.
With the new contract, KEPRO will provide services to support the management of the Emergency Medical Assistance (EMA) program. EMA covers the care and treatment of non-citizens who would otherwise qualify for Medicaid for emergency medical conditions provided in the Emergency Department or inpatient hospital. EMA also covers some care and treatment provided in other settings without which a patient’s health would be in serious jeopardy, including dialysis and cancer treatments. KEPRO will review submitted Care Plan Certification requests to determine if individuals meet established criteria for coverage.
KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. To learn more about KEPRO, visit www.KEPRO.com.
HARRISBURG, PA – KEPRO is pleased to announce the appointments of Meghan Harris as Executive Vice President and Michael Wolf as Vice President for Government Relations.
In addition to being the Chief Operating Officer, Harris has also been appointed as the Executive Vice President and now heads Operations, IT, Health Service Research and Quality for KEPRO. Harris is also responsible for KEPRO’s public and commercial operations, providing operational leadership to achieve company-wide goals and objectives. Harris brings nearly 17 years of experience in the health services research field, with expertise in biostatistics, experimental design, sampling, regression, health outcomes, and savings calculations.
“Meghan has been a keystone in the fabric of KEPRO and the work that we do,” said KEPRO President and CEO Joseph A. Dougher. “We’re very excited to have her as our Executive Vice President and operational leader in achieving our goals and objectives.”
Harris earned her Bachelor of Science degree in mathematics from Malone College in Canton, Ohio; and her Master of Science degree in Statistics from the University of Akron. She is a member of the Cleveland Chapter of American Statistical Association, the American Society for Quality, and the American Health Quality Association.
In addition, KEPRO is pleased to announce that Wolf will lead public affairs and policy efforts on a national level on a variety of health care initiatives including access to care and integration of care issues in public healthcare payer programs.
“Michael‘s expertise and experience in state government will be invaluable as we grow and increase our government and commercial clients,” Dougher stated. “He will be the lead on coordinating with government entities to develop effective and cost-efficient programs for their members.”
With more than 10 years of experience in the health industry and most recently serving as the Secretary of the Pennsylvania Department of Health, Wolf will play a crucial role in developing new government partnerships and identifying innovative ways KEPRO can better serve our clients and their members through cost-saving measures.
Wolf is recognized as the leader of Pennsylvania’s State Innovation Model efforts with the Center for Medicare and Medicaid Innovation Center spearheading efforts to create greater adoption of patient-centered medical homes and greater use of technology to help address medically-underserved. Wolf will also oversee KEPRO’s Communications Office to better align KEPRO’s brand and to enhance two-way communication with clients and members.
KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. To learn more about KEPRO, visit www.KEPRO.com. Read More